Diabetes

Introduction

Diabetes is diagnosed when your fasting blood sugar is greater than 126 on at least two repeated occasions. At this point your care provider may check a lab value called a hemoglobin A1C, which is essentially a way to see how well your blood sugar has been controlled over the past 3 to 4 months. Some of the symptoms of diabetes are feeling thirsty all the time and drinking more fluids (polydipsia) and consequently having to urinate more often (polyuria), as well as difficulty losing weight or slowly gaining weight, feeling sluggish (mentally and physically) after eating and at other times. If you have any of these symptoms, and especially if you have a family history of diabetes type 2, you should be tested for diabetes.

Diabetes (type 2 or "adult onset") can be considered to be at one end of a spectrum of a disease syndrome called Syndrome X that includes: Insulin resistance, elevated lipids/triglicerides (blood fats), elevated blood pressure and obesity. Chronic elevated blood glucose can damage most every organ in your body, usually affecting the small vessels first resulting in damage to your eyes, kidneys, and nerves - leading to the most common symptoms and complications. A diet high in refined carbohydrates is a major contributing factor to the development of Syndrome X. Over time, increased sugar intake, in any form, results in increased insulin production, which leads to increased lipids/triglycerides, increased blood pressure, obesity, insulin resistance and finally diabetes.

If you are found to have elevated blood glucose, but it is less than 200 mg/dl on the average, dietary modification and weight loss is the first step. If you can decrease your intake of refined carbohydrates as outlined next, you will be able to remarkably decrease your glucose levels. If you have a sedentary lifestyle, expect an increase in your activity level to also have a profound effect. Most people who develop type 2 diabetes are overweight, eat a diet high in refined carbohydrates and do not exercise enough. As you increase your activity level, your muscles will require more glucose, lowering the serum (blood) levels. As you exercise more, and eat less refined carbohydrates, you will lose weight, decreasing insulin resistance. Working with your physician, it would be reasonable to try some of the natural treatment options such as chromium, fenugreek and/or gymnema before resorting to conventional diabetic medication.

Dietary Considerations

Eat a diet high in fiber

Studies repeatedly show that a diet high in dietary fiber (25 to 30 gm) can significantly lower blood glucose levels.
Eat NO refined carbohydrates. This includes:
Refined flour
Enriched flour, bleached flour, semolina flour, wheat flour. Examples include: pizza, pasta, bagels, pretzels, tortillas, muffins, breads, baked goods.
Refined rice
Enriched rice, polished rice, rice flour.
Sugar / concentrating sweeteners
Anything ending in -ose, including fructose, syrups.
Eat foods as natural and unprocessed as possible
Eat non-starchy vegetables
Examples: All lettuce, greens, asparagus, bok choy, broccoli, cauliflower, celery, cucumber, green/red/chinese cabbage, mushrooms, spinach, sweet/hot peppers, tomatoes, yellow wax/green beans, zucchini/summer squash.
Eat less natural carbohydrate-dense food
This includes: whole grains, starchy vegetables (roots: potatoes, carrots), legumes, fruits. When eaten, these foods should be eaten with protein and/or fat to buffer the glucose elevating effect.
Do not drink soft drinks, fruit juices or alcohol.
Use olive oil only (higher in omega 3 FA), not regular vegetable oils
Eat more omega 3 FA whenever possible
Sources: cold water fish (salmon,trout, tuna) - 2 to 3 times per week. Also, sardines, herring, anchovies, flaxseed oil, walnuts, romaine lettuce, mesclun mixed greens, argula, kale, collard greens, swiss chard.
Avoid trans-fatty acids
Examples: margarine, deep fried foods, partially hydrogenated oils - salad dressings, crackers, breads, cookies, pastries
Eat protein at every meal and snack
Good sources: Chicken, turkey, fish, seafood, red meat, lamb, game meat, eggs, low fat cheese (mozzarella, feta, low/no fat cottage cheese). Allow 3-4 ounces per meal.
Alternative sources: Seeds/nuts. These are healthy snacks, protein - mostly monounsaturated fats. Seeds contain the most protein.

Consider the glycemic index when choosing foods. If you are diabetic, you should avoid high glycemic index foods, concentrating on mostly low and occasional moderate glycemic index foods.

Adapted from Syndrome X: The Complete Nutritional Program to Prevent and Reverse Insulin Resistance

Nuritional Support

Magnesium

Common deficiency in diabetes
Needed for: muscle relaxation, blood clotting, manufacturing of ATP (energy)
Sources: Kelp, wheat bran/germ, almonds, cashews
Dose: 250-600 mg daily

Zinc

Deficiency common in diabetes
Needed for: Immune function
Sources: Oysters, seeds, nuts, peas, whole wheat, rye, oats
Dose: (Adults) Males: 15 mg; Females 12 mg daily. Do not take with high fiber foods

Vitamin C

Deficiency common in diabetes
Needed for: Wound repair, immune system, may help to decrease sorbitol accumulation on RBCs
Sources: Red chili peppers, sweet peppers, kale, parsley, collard greens, turnip greens, broccoli, brussel sprouts, watercress, cauliflower, cabbage, strawberries, citrus
Dose: 500 to 1000 mg daily

Vitamin A

Deficiency common in diabetes
Use (as beta-carotene): Macular degeneration, cataracts
Sources (Vitamin A): Liver and dairy products, carrots, apricots, collard greens, kale, sweet potatoes, parsley, spinach, and cod liver oil. (Beta-carotene): Dark green and orange-yellow vegetables: carrots, sweet potatoes, squash, spinach, romaine lettuce, broccoli, apricots, and green peppers.
Dose: 5000 IU (3 mg beta-carotene)
Food sources are best, beta-carotene is the safest supplement (recommended in pregnancy)

Vitamin E

Increased need in diabetics
Use: May improve glucose control, cataracts
Sources: Polyunsaturated vegetable oils, seeds, nuts, whole grains
Dose: 800 IU (look for mixed tocopherols)

Manganese

Use: Glucose control, energy metabolism, thyroid hormone function
Sources: Whole grains, legumes, avocados, grape juice, seaweed, egg yolks, nuts, seeds, boysen-berries, blueberries, pineapple, spinach, collard greens, peas, green vegetables
Dose: 5 mg

Natural Treatment Options

Chromium Picolinate

Use: Decrease glucose levels, increase glucose tolerance, decrease insulin levels, decrease obesity, decrease total cholesterol/ triglycerides.
How: Increases efficiency of insulin
Dose: Up to 1200 mcg daily in divided doses

American Ginseng (Panax quinquefolius L) 

Use:  Reduces postprandial (after meals) glycemia (glucose increase).  One recent study showed that glucose levels following a glucose load were reduced in non-diabetics and Type 2 diabetics if taken before meals (40 minutes), and in Type 2 diabetics only, if taken with a meal.
Dose: 3 gm, up to 40 minutes before, or with meals.

Fenugreek (Trigonella Feonumgraecum)

Use: Decrease glucose levels, increase glucose tolerance, decrease cholesterol/triglycerides, decrease postpyrandial (after meals) glucose increase
Dose: 5 to 30 g (defatted) three times daily with meals
Safety concerns: In pregnancy, not > 5gm/day

Gymnema sylvestre

Use: Improved glucose control, decreased insulin requirements.
How: Increased insulin secretion, enhanced effectiveness
Dose: 400 to 600mg daily, extract standardized to 24% gymnemic acids

Garlic

Use: Decrease glucose levels, decrease cholesterol (9 to12%)
How: Competes with insulin activating sites in the liver = increased free insulin
Dose: 900 mg daily, extract standardized to 1.3% alliin (12 mg alliin)

Bilberry (Vaccinium myrtillus)

Use: Diabetic retinopathy, decrease easy bruising, may help control glucose levels
How: Increases intracellular vitamin C levels, decreases leakiness of small vessels – has an affinity for the eye, antioxidant
Dose: 120 to 240 mg twice daily, standardized to 25% anthocyanoside content

Alpha-Lipoic Acid

Use: Neuropathy, control glucose levels, decrease insulin resistance, increase insulin sensitivity
How: Antioxidant (fat and water soluble)
Dose: 300 to 600 mg divided twice/three times daily

Gamma-Linoleic Acid (GLA) (Omega 6 Fatty Acid)

Use: Diabetic neuropathy
How: Protects nerves
Source: Evening primrose oil (EPO), borage oil, black current oil
Dose: 4 to 6 mg EPO or 2-3 g borage oil daily with food

Fiber

The consumption of 25 to 30 gm of soluble per day can accomplished easily by consuming at least five servings of fruits and/or vegetables and six or more servings of grains daily.  Beans and legumes also provide excellent sources of fiber.

Alternately, psyllium in the dose of 5 gm three times daily (before meals) has been shown to decrease glucose, total cholesterol, triglycerides, and LDL levels, and increase HDL levels significantly.

Conclusion

Type 2 diabetes is most often the result of a diet high in refined carbohydrates and a sedentary lifestyle, resulting in weight gain and ultimately insulin resistance. A change in your diet, an increase in your activity level, and a decrease in your weight can and will help your body metabolize glucose more effectively resulting in an overal decrease in your serum glucose levels and a decrease in insulin resistance. The cornerstone of the treatment of type 2 diabetes is: diet, exercise, and weight loss. Do not count on medication to treat your diabetes - it is YOUR responsibility. The more responsibility you take, the greater your success and the less harm to your body. If diet, exercise and weight loss are not sufficiently effective, consider the natural alternatives as outlined - working closely with your physician. Also consider the nutritional support as outlined, always attempting to obtain the recommended doses within your diet before resorting to supplements.

Diet

High in fiber
NO refined, processed carbohydrates
Foods as natural as possible
Avoid starchy vegetables
Consider the glycemic index
Eat protein at every meal and snack
Eat any carbohydrate with protein and/or fat

Nutritional Support

Magnesium - 250 to 600 mg daily
Zinc - 12 to15 mg daily
Vitamin C - 500 mg daily
Vitamin A - 5000 IU (3 mg beta-carotene) daily
Vitamin E - 800 IU daily
Manganese - 5 mg daily

Natural Treatments

Chromium Picolinate - 400 to 600 mg daily
American Ginseng - 3 gm, up to 40 minutes before, or with meals
Fenugreek - 5 to 30 g three times daily
Gymnema - 400 to 600 mg daily
Garlic - 900 mg = 12 mg alliin daily
Bilberry - 120 to 240 mg twice daily
Alpha-Lipoic acid - 300 to 600 mg divided two-three times daily
Gamma-Linoleic acid - 4 to 6 mg EPO, 2 to 3 g borage oil daily